Section 13-7-25 – Insulin for diabetes; cost-sharing cap.
Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall cap the amount an insured is required to pay for a preferred formulary prescription insulin drug or a medically necessary alternative at an amount not to exceed a total of twenty-five dollars ($25.00) per thirty-day […]
Section 13-7-26 – Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)
A. Until January 1, 2027, group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services. B. For the purposes of this section: (1) “behavioral health services” means professional and ancillary […]
Section 13-7-20 – Prior Authorization Act.
Benefits administrators of group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act are subject to and shall comply with the Prior Authorization Act [59A-22B-1 to 59A-22B-5 NMSA 1978]. History: Laws 2019, ch. 187, § 1 ANNOTATIONS Effective dates. — Laws 2019, ch. 187 contained no effective […]
Section 13-7-21 – Physical rehabilitation services; limits on cost sharing.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of physical rehabilitation services shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied […]
Section 13-7-22 – Coverage for contraception.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs shall provide, at a minimum, the following coverage: (1) at least one product or form of contraception in each of the contraceptive method categories identified by the federal food and […]
Section 13-7-23 – Pharmacist prescriptive authority services; reimbursement parity.
A group health plan shall reimburse a participating provider that is a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who provides a service at the standard contracted rate that the group health plan reimburses, for the same service under that group health plan, any licensed physician or physician assistant licensed […]
Section 13-7-24 – Heart artery calcium scan coverage.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for eligible insureds to receive a heart artery calcium scan. B. Coverage provided pursuant to this section shall: (1) be limited to the provision of a heart artery calcium scan to an eligible […]
Section 13-7-15 – Prescription drugs; prohibited formulary changes; notice requirements.
A. As of January 1, 2014, group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations shall not make any of the following changes to coverage for a prescription […]
Section 13-7-16 – Coverage for autism spectrum disorder diagnosis and treatment; permissible limitations.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for: (1) well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and (2) treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy and applied behavioral analysis. B. […]
Section 13-7-17 – Pharmacy benefits; prescription synchronization.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a prescription drug benefit shall allow an enrollee to fill or refill a prescription for less than a thirty-day supply of the prescription drug, and apply a prorated daily copayment or coinsurance for the […]